<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('可提现金额(¥)')}:</label>
        <div class="col-xs-12 col-sm-4">

            <input id="id-balance" name="row[balance]" class="form-control" type="text" value="{$row.gain.balance|htmlentities}" disabled>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('提现金额(¥)')}:</label>
        <div class="col-xs-12 col-sm-4">

            <div class="input-group">
                <input id="c-amount" data-rule="required" class="form-control" name="row[amount]" type="text" value="">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button"  class="btn btn-info btn-cash"><i class="fa fa-upload"></i> 全部提现</button></span>
                </div>
            </div>
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('到账银行卡')}:</label>
        <div class="col-xs-12 col-sm-8">

            <div class="input-group">
                <div class="input-group-addon no-border no-padding">
                    <span class="form-control" disabled>{$row.card_type|htmlentities}{$row.bank_account|htmlentities}</span>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('短信验证码')}:</label>
        <div class="col-xs-12 col-sm-6">
            <div class="input-group">
                <input id="c-card_id" data-rule="required" data-source="card/index" class="form-control" name="row[card_id]" type="number" value="">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button"  class="btn btn-info"  data-url="{:url('ajax/thumbs')}"><i class="fa fa-upload"></i> 发送短信验证码</button></span>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Memo')}:</label>
        <div class="col-xs-12 col-sm-8">
                <textarea id="c-summary" class="form-control " rows="5" name="row[summary]" cols="50" placeholder="最多输入50个字"></textarea>
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
